With every passing year, I’m reminded of the special privilege of growing older. My beautiful big sister died when she was just 23, the delayed result of having been hit by a drunk driver while walking in daylight in our working-class neighborhood. She left behind grieving family members and friends who were forever transformed by her loss. I’ve studied health statistics for decades, and the words of the late medical researcher Irving Selikoff ring true to me, “Statistics are people with the tears wiped away.”
Sadly, many other countries do a much better job at keeping their young people alive. As one of the world’s wealthiest nations, so could we. I’m dismayed by anyone who dismisses early deaths from preventable causes as inevitable facts of life. We can and should take steps today to help our younger generations survive and thrive.
Even before the pandemic, the U.S. ranked well below other wealthy countries in life expectancy at birth, a hypothetical measure based on current, age-specific death rates. An expert panel of the Institute of Medicine termed this lower ranking the “U.S. health disadvantage” in 2013, due largely to higher death rates before age 50. Over time, the gap in life expectancy has grown between the U.S. and other countries. A more recent analysis ranked the U.S. a dismal 42nd among countries in life expectancy at birth in 2021, 8.3 years shorter than the highest ranked country.
Stories abound about the latest research on healthy aging. I’ve written about community-based approaches to prevent disease and promote health among our growing population of older adults. But aging can’t be taken for granted. Too many of our young people die early, and the problem is getting worse. At younger ages, most deaths are from unnatural causes. From early childhood until midlife (ages 1 to 44 years), unintentional injuries—such as drug overdoses, motor vehicle accidents, and firearm injuries—are the leading cause of death. For people aged 10 to 24, suicide ranks second and homicide ranks third, and death rates for both have been on the rise in recent years.
To improve life expectancy, improved access for all to affordable, quality health care will be essential. But efforts need to extend beyond health care, to address both the immediate and underlying causes of these preventable deaths.
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The circumstances and context in which young people live, work, and play have a tremendous influence on their lives. A long-term study that followed more than 46,000 young people over five decades showed negative experiences such as poverty and neglect in early childhood contributed to shortened lives. A recent study that followed more than 2,000 school children in Baltimore over 30 years found those who lived in poor neighborhoods as children were at greater risk of death from unnatural causes in early adulthood.
The problems that contribute to early deaths are complex but not unsolvable. Life expectancy at birth within the U.S. by county can vary by as much as 20 years. This variation suggests solutions may need to be community-based and tailored to local circumstances. We already have knowledge about many community-based strategies that work to keep people well. An analysis of shifts in state-level policies and life expectancy in 18 states linked longer life expectancy with the adoption of more liberal policies in areas such as tobacco taxation, minimum wage, and the protection of immigrants, civil rights, and the environment. Disparities in life expectancy can be changed through changes in policies.
Policy decisions should be informed by evidence about the likely consequences of different options on population health, not just ideology. Proponents should be required to document the potential impact of all major policy and budget decisions on the health and well-being of our younger generations. People with the relevant technical and lived experience need to be at the table to discuss ways to maximize the benefit and minimize the harm of policies to affected communities, both immediate and long-term.
Where needed, the federal government could increase support for improved data for decision-making. For example, this summer the surgeon general issued an advisory on firearm violence, the leading killer of children and adolescents. The advisory called for federal investments in improved data systems at the national, state, and local levels, as well as increased investments in research to fill knowledge gaps in several key areas.
We can ill afford to remain complacent about the worsening U.S. health disadvantage. The future of our nation depends on the strength of the generations who follow ours. Each year, an increasing number of young people have their lives cut short, and we lose what could have been their unique gifts to our world. Those of us lucky enough to grow older can pay it forward by advocating for the protection and support of this most precious national resource.
Mary C. White is a Public Voices fellow at Academy Health in partnership with The OpEd Project, an adjunct professor at the Rollins School of Public Health of Emory University, and a retired federal epidemiologist.
The views expressed in this article are the writer’s own.
